Flu vaccine: Walk the talk, get the shot

With ample vaccine expected, physicians top the list of those who should get immunized.

Posted Oct. 27, 2008.

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One statistic -- 42% -- has become a rallying cry for flu vaccine advocates. It quantifies the number of health professionals, including physicians, who get the annual shot. Public health experts say there are far too few.

Flu vaccine uptake for this population has improved since 1981, when the Centers for Disease Control and Prevention first recommended the immunization for all health care workers. But in the last decade, coverage has hit a plateau -- with fewer than half consistently rolling up their sleeves.

This reality has become a serious call to action. It's echoed by numerous health care organizations, including the American Medical Association, which have recommended that health professionals step up and get immunized.

AMA policy encourages physicians and other health workers not only to be role models, but also to advocate the flu vaccine to their patients. In addition, the AMA has joined with the CDC to sponsor the National Influenza Vaccine Summit, which works to stabilize vaccine supplies and increase coverage rates.

The reasons why the focus on health professionals has taken on a high level of importance deserve reviewing. For starters, left unchecked, the flu's disruptive power can significantly undermine practice as usual. One recent study found that an outbreak in an internal medicine ward affected 23% of staff and resulted in 14 days of sick leave, postponement of eight scheduled admissions and suspension of emergency admissions for 11 days.

Even more compelling is the issue of patient safety. When health professionals are vaccinated against the flu, they not only keep themselves and their close contacts healthy, they also advance the pledge to do no harm by shielding patients, many of whom are at the highest risk for flu-related complications.

Research demonstrates that increasing health professionals' flu vaccination rates is aided by systemic involvement. For instance, when health care institutions commit to providing vaccine to employees on-site, at convenient times, and at little or no cost, studies show uptake improves.

To this end, more than 1,300 hospitals have signed on to the "flu vaccination challenge." The initiative was launched in September by Joint Commission Resources, a nonprofit publishing affiliate of the Joint Commission. It will recognize hospitals that top the 42% national rate.

The emphasis on vaccinating health professionals, though, is only one element of a multipronged anti-flu attack. After all, CDC data show that one in five Americans gets the flu every year. Of these cases, 200,000 are hospitalized and about 36,000 die. And when combined with pneumonia, influenza is the nation's eighth leading cause of death.

Currently, flu vaccine recommendations cover about 84% of the population. Basically, the only people not included are children younger than six months, and healthy adults who have no contact with anyone who is not healthy or in an at-risk category. And with 143 million to 146 million doses expected to be available in the coming months, physicians should take every opportunity to discuss the vaccine with patients.

A recent survey by the National Foundation for Infectious Diseases found that this conversation is important. A majority of respondents said they would get vaccinated if their physician recommended it. A large number also said they would likely continue to receive it annually.

Moreover, with vaccine so plentiful, public health officials are urging health professionals to extend the traditional immunization season through November, December and beyond. The CDC has designated Dec. 8-14 as National Influenza Vaccination Week to underscore this message. And physicians should use this time to increase the number of patients they immunize who are targeted by the CDC and the Advisory Committee on Immunization Practices.

All of these steps combine to make up a noble effort. After all, each year the flu exacts a hefty cost on the nation's public health, in both human and economic terms. The availability of vaccine provides a means to prevent much of this morbidity and mortality. Physicians should step forward and set an example -- taking care of themselves, their families and their patients.

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